The Road Accident Fund (RAF) has been issued with a punitive high court cost order and directed to pay a road accident victim R2.23 million after it refused to compensate the claimant for past hospital and medical expenses.
The fund’s refusal was based on the fact that these costs had already been covered by the claimant’s medical aid, despite binding full court judgments and confirmation by the Supreme Court of Appeal (SCA) of the RAF’s liability to pay these medical costs.
RAF must pay within 6 months
Acting Judge M Louw, in a judgment handed down in the Western Cape High Court last week, ordered the RAF to pay Advocate Roxanne van Wyk R2 231 081.34 on behalf of Catherine Yiannakis for her past hospital and medical expenses within 180 days.
The RAF was sued for damages related to bodily injuries sustained by Yiannakis in a motor vehicle collision on 12 February 2018 as a pedestrian.
Since the accident, Yiannakis has been unable to live independently and has, since approximately July 2018, resided at a care facility providing specialised long-term care and nursing of persons with chronic psychiatric and mental disorders.
Medical costs
Louw said the merits of the claim were conceded by the RAF, and damages were settled between the parties in line with a court order dated 5 August 2024 – apart from a dispute about the quantum for past hospital, medical and related expenses.
These costs amounted to R2 231 081.34, comprising:
- R1 678 832.58 payable to Yiannakis; and
- R552 248.76 due to Discovery Health Medical Scheme (DHMS).
The RAF disputed its liability to pay the R552 248.76 for Yiannakis’s past hospital and medical expenses already paid by Discovery, her medical aid provider.
The matter was initially enrolled for trial on 19 August 2025.
However, in light of a pending appeal before a full court of the Western Cape High Court at the time – concerning, among other things, the RAF’s liability to pay past hospital and medical expenses already covered by a patient’s medical fund – the parties agreed to postpone the trial to 28 April 2026.
In the meantime, a full court of the Western Cape High Court on 9 February 2026 dismissed with costs an appeal by the RAF against a judgment ordering the fund to pay Nicolaas Johannes van Wyk’s past medical expenses, amounting to R350 187.56 for injuries sustained in a motorcycle accident.
Louw said that despite the ruling by the full court on this issue, the trial nevertheless proceeded before the Western Cape High Court on 28 April 2026.
RAF decided it is ‘not liable’
In the judgment in the Yiannakis matter, Louw said the RAF had adopted the position that it is not liable where medical aid schemes have settled past medical expenses.
This stance led to the first directive issued by the RAF on 12 August 2022, which was subsequently reviewed and set aside by Judge Mandla Mbongwe in October 2022.
Mbongwe held that the RAF Act did not exclude benefits received from private medical aid schemes and interdicted the implementation of this directive.
Louw said the RAF’s applications for leave to appeal were refused by both the SCA and Constitutional Court.
Despite this, the RAF proceeded to issue two further directives.
Breach of court order
The second RAF directive, issued on 13 April 2023, required the exclusion of expenses categorised as prescribed minimum benefits (PMBs) or emergency medical conditions (EMCs), while the third RAF directive, issued on 2 November 2023, excluded claims where claimants had agreed to reimburse their medical aid schemes.
Discovery Health applied for a declarator that the RAF was in breach of a high court order.
This resulted in a judgment by a full court of the High Court in Pretoria, comprising Gauteng Division Judge President Dunstan Mlambo and Judge Noluntu Bam, with Judge Ingrid Opperman dissenting, ruling that the RAF is not liable for the payment of the past medical expenses of road accident victims whose medical schemes have already paid those costs.
Judge Ingrid Opperman, in her dissenting judgment, said it was unlawful to reject claims merely because a medical aid scheme had already paid.
A judgment by the SCA to an appeal by DHMS against this majority judgment is pending.
‘Untenable’
Louw said last week that even if the RAF’s defences are upheld in the SCA appeal, the outcome will not affect the Yiannakis case, given that such directives by the RAF cannot operate retrospectively.
Louw added that it was settled law in the Western Cape Division of the High Court that the RAF cannot refuse claims for past medical expenses on the basis that they were paid by a road accident victim’s medical scheme.
Louw said it appears to have become a recurring practice for the RAF to attempt to circumvent court orders and even statutory provisions in order to avoid or diminish its liability through the issuing of directives, and that the Yiannakis matter before her was no exception.
“In my view, the RAF’s reliance on the prospect of a future successful appeal to avoid liability for past hospital, medical and related expenses is untenable.
“A court is required to interpret and apply the law as it stands at the time the matter is heard, not as it might be determined in future.”
Louw found that Advocate Van Wyk, on behalf of Yiannakis, has discharged the onus of proving that the RAF is liable to pay the full amount of R2 231 081.34 in respect of past hospital, medical and related expenses.
Judge criticises ‘frivolous’ opposition
Louw said the claim for costs involved a substantial amount exceeding R2.5 million, stressing that costs lie within the discretion of the court and that punitive awards are rarely made, being reserved for conduct that is dishonest, fraudulent, vexatious or malicious.
However, she said the RAF could not in good faith have opposed this matter before her, and its opposition was frivolous.
She found that its conduct – “reflected in a flimsy defence, refusal to accept the binding full court decision in [the case involving Nicolaas Johannes] van Wyk, and total disregard for established obligations – warrants a punitive costs order”.
“It is wholly unacceptable that the RAF persists in defending these hopeless matters, thereby wasting public resources, driving up legal costs for both the RAF and claimants, and compelling claimants to incur unnecessary expenses to enforce rights already established.
“This approach not only exposes the RAF to further adverse costs orders when claimants succeed, but also contributes significantly to delays and backlogs in the finalisation of claims,” Louw said.
This article was republished from Moneyweb. Read the original here.
